Controversies in lung cancer screening

Area of Science:

• Pulmonology
• Radiology
• Oncology

Background:

• Lung cancer remains a leading cause of cancer death globally.
• Despite advances in treatment, survival rates for advanced lung cancer are poor.
• Screening aims to detect lung cancer earlier, potentially improving outcomes.

Purpose of the Study:

• To review the evidence supporting lung cancer screening.
• To discuss the challenges and controversies surrounding screening implementation.
• To provide guidance for radiologists regarding screening practices.

Main Methods:

• Review of major lung cancer screening trials (e.g., National Lung Screening Trial).
• Analysis of concerns including imaging workflow, radiation exposure, and nodule management.
• Discussion of biases (overdiagnosis, lead-time, length-time) and cost-effectiveness.

Main Results:

• Major trials demonstrate a reduction in lung cancer-specific mortality with low-dose CT screening.
• Significant concerns persist regarding practical implementation and potential harms.
• Radiologic practice is central to addressing screening challenges.

Conclusions:

• Lung cancer screening with low-dose CT is supported by evidence of mortality reduction.
• Careful consideration of workflow, radiation, nodule management, and biases is crucial.
• Radiologists play a key role in optimizing lung cancer screening programs.